Fall sports season is in full swing and I've already seen a number of athletes who have suffered concussions. Concussions have always been a part of sports, especially those involving high-energy collisions such as football, hockey, basketball and soccer. I'm sure you have read or heard that research is allowing us to get firmer grasp on how to manage concussed athletes.
A concussion is a trauma-induced alteration in mental status that usually does not involve a loss of consciousness and does not have to be a result of a blow to the head. In fact, only 10 percent of concussions are associated with a loss of consciousness. What to do with the remaining 90 percent has been a subject of debate for many years.
Concussions result when the soft brain tissue moves around inside the bony skull. This can result in varying degrees of injury to the brain that usually does not show up on radiology imaging studies like CT or MRI scans.
Concussions alter the ability of the brain to use energy - the brain's demand for energy exceeds what can be delivered, resulting in many signs (observable by others) and symptoms (what the athlete feels) of concussion. A key point to remember is that the brain is at increased risk of further injury until this mismatch of supply and demand is resolved.
Concussion signs may include appearing dazed or stunned, being confused about plays or assignments or being unsure of the opponent or the score of the game. Observers may note the player is moving clumsily, saying nonsensical things, or exhibiting mood changes such as aggression or sadness. The athlete may have amnesia, either retrograde (forgetting what happened before the incident) or anterograde (forgetting events after the incident - a more concerning sign).
Athletes usually report a headache. Other common symptoms may include nausea, dizziness, balance problems, blurred or double vision, light or noise sensitivity, "brain fog," concentration or memory problems, fatigue, mood changes and change in sleep patterns.
Athletes who sustain a concussion should be immediately removed from the contest or practice until they are evaluated by an athletic trainer or physician who is familiar with concussion management. This is critical, especially in younger athletes, who appear to be more susceptible to potential severe neurologic injury if they are allowed to return to competition before recovering from a concussion. In fact, beginning July 1, 2012 Indiana law requires schools to disseminate information on concussions to interscholastic and intramural teams. Athletes and their parents are required to sign off that they receive the materials.
Although an athlete's signs and symptoms may appear to resolve, the very real possibility exists that the brain has not recovered completely. There are subtle neurologic changes that often can't be picked up by doing a physical examination.
Computerized neurologic tests have been developed that have enhanced the management of concussions. They are much more objective and, most importantly, are helping us get athletes back on the field more safely. Typically, athletes take a baseline examination at the start of the season and repeat the test following a concussion. Athletes are kept out of competition until their test returns to their baseline. The ImPACT test (Immediate Post-concussion Assessment and Cognitive Testing) was developed at the University of Pittsburgh Medical Center and is the most commonly used neurocognitive test.
All NFL and NHL teams and most colleges utilize concussion management software. Thankfully, its use has filtered down to the high school level in many areas. Most doctors consider these tests to be the standard of care for concussion management. If your team is not using it, you need to ask why - the cost is very reasonable.
Despite proper management, some athletes develop "post-concussion syndrome." They may continue to have symptoms, particularly a headache, for weeks or even months following their injury.
There are steps that can be taken to help reduce the risk of suffering a concussion. It is critical to teach players to wear properly fitted safety gear and instruct on proper technique, especially tackling in football.
All coaches and players should be educated to recognize concussions and the serious nature of even a "minor" concussion. Athletes need to be taught to report their own or their teammates' symptoms or signs immediately.
More information may be found at www.cdc.gov/TraumaticBrainInjury/